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Cumulative Experience (cumulative + experience)

Distribution by Scientific Domains

Medical Sciences	80%

Selected Abstracts

Tracheolaryngeal Complications of Inherited Epidermolysis Bullosa: Cumulative Experience of the National Epidermolysis Bullosa Registry,

THE LARYNGOSCOPE, Issue 9 2007
Jo-David Fine MD
Abstract Objectives/Hypothesis: To accurately determine the frequency with which complications arise in the ears, noses, and throats of patients with inherited epidermolysis bullosa (EB) as well as the cumulative risk of tracheolaryngeal stenosis or stricture. Study Design: Cross-sectional study (3,280 patients) with a nested, randomly sampled longitudinal subcohort (n = 450), representing data collection, stratified by major EB subtype, of the National EB Registry, an epidemiologic project focused on enrolling all EB patients within the continental United States from 1986 to 2002, to permit generalization of findings to the entire American EB population. Methods: Systematic epidemiologic case finding and data collection were performed throughout the continental United States, followed by subclassification of patients by EB subtype. ENT complications were quantified via contingency tables (as frequencies) and lifetable analyses. Frequencies of surgical procedures were also determined. Results: The most important clinical ENT complication in inherited EB was tracheolaryngeal stenosis or stricture, arising during early childhood and primarily within infants and children with junctional EB (JEB) (cumulative risk of 39.8% and 12.8% in Herlitz and non-Herlitz JEB, respectively, by ages 6 and 9). Other uncommon complications included chronic otitis media, chronic otitis externa, and hearing loss. Conclusions: Given the potential risk for sudden airway occlusion and death, meticulous surveillance by a pediatric otolaryngologist is a critical part of the overall management of infants and children with EB, especially those with JEB and two rare subtypes of generalized EB simplex. Elective tracheostomy should be considered in EB infants and children with evidence of airway embarrassment. [source]

Therapeutic Hotline: Re-induction may be useful to manage psoriasis relapse during long-term maintenance treatment with infliximab: a retrospective analysis

DERMATOLOGIC THERAPY, Issue 2 2010
Gino Vena
ABSTRACT Infliximab is an anti-tumor necrosis factor-alpha monoclonal antibody that is highly effective for the treatment of psoriatic disease. During maintenance treatment, some patients may experience a disease relapse, and, in such circumstances, dose intensification is frequently used to regain efficacy. We report our cumulative experience on the use of infliximab re-induction in patients whose psoriasis relapsed during long-term maintenance treatment with infliximab. From September 2005 to January 2009, 22 patients required re-induction because of a relapse of their psoriasis. Re-induction was effective in restoring response in most patients and was well tolerated in all cases, without occurrence of serious or unexpected adverse events. [source]

Assessing competency in Dentoalveolar surgery: a 3-year study of cumulative experience in the undergraduate curriculum

EUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 4 2007
J. A. Durham
Aim:, To assess and observe the development of competence in oral surgical skills during a 3-year undergraduate programme. Method:, Over a 3-year period 75 students were followed through from the beginning of their clinical course to their Bachelor of Dental Surgery graduation and their surgical experience monitored by the use of logbooks. Their development of competence was assessed objectively through structured assessments and subjectively by a single tutor responsible for each year. Assessments were made of their ability in exodontia, pre-surgical assessment and the surgical extraction of teeth/roots. Results:, Seventy-three students completed the course (97%). Successful completion rates for the objective testing were 100% for both exodontia and pre-surgical assessment. The surgical assessment, (surgical extraction of a tooth or root) had a successful completion rate of only 23% and the caseload for students was low with a mean of four teeth removed surgically upon graduation. Relationships were examined between total numbers of teeth extracted, total number of minor oral surgical procedures completed and the successful completion of the surgical competence assessment, but no significant relationships were found. Conclusions:, This study demonstrates that it is possible to achieve objectively measurable levels of competence in undergraduates undertaking oral surgery procedures. It is however, a labour and time intensive process and appropriate clinical and teaching resources are required. National co-operation towards agreed standardised competencies should be encouraged to allow data to be pooled and more powerful analyses to occur. [source]

INCREASED AVOIDANCE OF SWIMMERS BY WILD BOTTLENOSE DOLPHINS (TURSIOPS TRUNCATUS) DUE TO LONG-TERM EXPOSURE TO SWIM-WITH-DOLPHIN TOURISM

MARINE MAMMAL SCIENCE, Issue 4 2001
Rochelle Constantine
Abstract The responses of wild, non-provisioned bottlenose dolphins (Tursiops truncatus) to swim attempts from commercial swim-with-dolphin tour boats were systematically observed during two research periods: 1994,1995 and 1997,1998. A total of 255 groups of dolphins was encountered during boat-based surveys and 36% (n= 93) were exposed to at least one swim attempt. The operators' success with swim attempts, defined as at least one dolphin milling within 5 m of at least one swimmer, decreased from 48% in 1994,1995 to 34% in 1997,1998, and avoidance responses to swimmers increased from 22% to 31%. Dolphin response was found to vary according to swimmer placement. The greatest increase in avoidance occurred when swimmers were placed in the dolphins' path of travel. Based on sighting records of 266 individually identified dolphins, it was estimated that an average dolphin was exposed to 31 swim attempts per year. This level of exposure suggests that individual dolphins have, with cumulative experience, become sensitized to swim attempts. When a swim attempt was successful, on average it involved 19% of the group. Age-class differences in interaction rates showed that juveniles were significantly more likely to interact with swimmers than adults. This study highlights the importance of longitudinal studies in evaluating human impact and suggests the urgent need for similar studies of potential human impact on other toothed cetaceans. [source]

Pulmonary hemorrhage/hemoptysis in children

PEDIATRIC PULMONOLOGY, Issue 6 2004
Simon Godfrey MD
Abstract Pulmonary hemorrhage and hemoptysis are uncommon in childhood, and the frequency with which they are encountered by the pediatric pulmonologist depends largely on the special interests of the center to which the child is referred. In those centers caring for children with cystic fibrosis or congenital heart disease, these will be by far the most common causes of hemoptysis. Other causes of hemoptysis are far less common, such as bleeding from localized lesions in the upper airway or tracheobronchial tree. Even less common is bleeding into the lungs as part of a systemic disease, usually with renal involvement (pulmonary-renal syndromes), such as systemic lupus erythematosis or Goodpasture's syndrome. Bleeding into the lungs in children with a bleeding diathesis probably only occurs in immunosuppressed children after transplantation. When no other cause is found for pulmonary hemorrhage, the presumed diagnosis is idiopathic pulmonary hemosiderosis. This review discusses the various causes of hemoptysis and pulmonary hemorrhage, and the appropriate investigations to aid in determining the correct diagnosis. The management and prognosis of idiopathic pulmonary hemosiderosis, based on cumulative experience from published reports, are considered in more detail. Pediatr Pulmonol. 2004; 37:476,484. © 2004 Wiley-Liss, Inc. [source]